What are the National Institute for Health and Care Excellence (NICE) guidelines for Hormone Replacement Therapy (HRT)?

From the Guidelines

Hormone replacement therapy (HRT) should be considered for women with severe menopausal symptoms, but its use should be limited to the lowest effective doses and for a limited period of time, as recommended by the most recent guidelines 1. The NICE guidelines for HRT recommend individualized treatment based on symptoms, medical history, and personal preferences.

• First-line treatment typically includes estrogen (such as estradiol) with a progestogen for women with a uterus (to prevent endometrial hyperplasia), while women without a uterus can take estrogen alone.
• Common regimens include continuous combined therapy (daily estrogen and progestogen) or cyclical therapy (continuous estrogen with progestogen for 12-14 days per month).
• Estrogen can be administered as tablets (1-2mg daily), patches (25-100mcg/24hrs), or gels (0.5-1.5mg daily), while progestogens include micronized progesterone (200mg daily) or synthetic options like norethisterone (1mg daily).
• Treatment should start at the lowest effective dose and be reviewed after 3 months, then annually.
• HRT effectively treats vasomotor symptoms, vaginal dryness, and helps prevent osteoporosis, as noted in the guidelines 1.
• The guidelines emphasize that HRT usage should be confined to women younger than the age of the expected natural menopause if at moderate or high risk of breast cancer, and its use beyond this age will require a discussion and consideration of individual risk factors 1.
• It is also important to consider the potential risks associated with HRT, including a small increased risk of breast cancer and cardiovascular and thromboembolic morbidity, as highlighted in earlier studies 1.

From the Research

NICE Guidelines for HRT

• The National Institute for Health and Care Excellence (NICE) provides guidelines for the use of Hormone Replacement Therapy (HRT) in menopausal women, but the specific details of these guidelines are not mentioned in the provided studies 2, 3, 4, 5.
• However, the studies suggest that HRT can be effective in alleviating menopausal symptoms and improving quality of life for women 3, 4, 5.
• The choice of HRT regimen, including the type of estrogen and progestogen used, can affect the risk of certain health outcomes, such as venous thromboembolism, cardiovascular disease, and breast cancer 3.
• The studies also highlight the importance of individualizing HRT regimens based on a woman's specific needs and medical history 3, 4, 5.

Types of HRT

• The studies discuss the use of different types of estrogens, including estradiol (E2) and conjugated equine estrogens (CEE), and progestogens, including progesterone (P4) and synthetic progestins 3, 4.
• The evidence suggests that E2 and P4 may have a more favorable safety profile compared to CEE and synthetic progestins, with potential benefits for cardiovascular health and breast cancer risk 3.
• However, more research is needed to fully understand the effects of different HRT regimens on women's health 3, 5.

Current Recommendations

• The studies provide an overview of the current recommendations for HRT use in menopausal women, including the benefits and potential risks associated with HRT 5.
• The evidence highlights the importance of careful consideration and individualization of HRT regimens to minimize risks and maximize benefits for women 3, 4, 5.